Bronchial asthma is a serious medical and social problem. Patients with mild bronchial asthma rarely visit medical institutions because of this
problem, so it is impossible to include them in official statistics. However, it should be noted that mild BA does not mean sufficient control over the symptoms of the disease and a low risk of acute conditions. Present literature review is devoted to the study of the main problems in diagnosing and managing patients with mild bronchial asthma, as well as to the methods of modern functional diagnostics used to verify obstructive changes. According to many literature sources, the main one is spirometry with bronchodilation tests. But in case of intermittent course of the disease, bronchial provocative tests or pulsed oscillometry might be used to confirm the diagnosis. Certain method or their combination is chosen according to particular clinical situation, as well as due to their hypersensitization.

Helicobacter pylori (H.p.) is one of the most common global pathogens that may lead to gastrointestinal pathologies, including ulcers, gastritis, lymphoma, and stomach cancer. Present review describes the components of eradication therapy, analyses clinical significance of H.p. resistance to main antibacterial drugs used in eradication therapy schemes. There are data on H.p. strains prevalence and resistant structure in different geographical areas
and reasons of resistance rise. Principles of pharmacodynamics of antibacterial drugs and molecular mechanisms of antibiotic resistance rise are described

The aim of the research is to study the role of association of genotypes and polymorphism alleles of VDR gene BsmI with ventilation disorders in children
with bronchial asthma.
Material and methods. For the period from 2015 to 2017 154 children with asthma of various severity (73 children with mild course, 22 with moderate
and 59 with severe asthma) and 34 relatively healthy children in a control group were examined. The groups of the examined are comparable by sex and age parameters. Molecular genetic typing of polymorphic locus BsmI c.IVS.G> A of VDR receptor gene (rs1544410, G63980A) was carried out.
Results. GG genotype of BsmI c.IVS.G> A polymorphism of VDR receptor gene is 4.4 times more common in patients with asthma compared with healthy individuals (26.6 % versus 6.0 %) (OR = 5.81, χ = 10.73, p = 0.005). AA genotype prevails in the control group, accounting 53 % versus 28 % in patients with BA.No statistical differences were found in distribution frequency of genotypes and alleles of BsmI polymorphism of VDR receptor gene in children with various asthma severity. Carriage of GG genotype is accompanied by sharp decrease in FEV1 and FVLC parameters to 41 % and 43 %, respectively, in children with bronchial asthma (p <0.05).
Conclusion. Children with bronchial asthma have higher incidence of GG genotype of BsmI c.IVS.G> A polymorphism of VDR receptor gene. Patients
carrying genotype GG G63980A polymorphism of VDR gene have a pronounced decrease in FEV1 and FVLC, which may indicate irreversible changes in bronchial wall architecture and can be regarded as a possible predictor of ventilation imbalance in this disease.This fact suggests certain contribution of polymorphism to implementation of structural disorganization during respiratory tract remodeling.

The aim of the research is to study the features of functional disorders in patients with pulmonary sarcoidosis (PS) using cardiopulmonary exercise testing with gas analysis (CPET).
Material and methods. 80 patients with PS were examined (43 males and 37 females), average age is 35 (29; 45) years. Radiologically 1-st stage of PS
was diagnosed in 10 cases, in 66 and 4 - 2 and 3 stages. Histologically, sarcoidosis was confirmed in 75 % of patients. Clinical symptoms, onset features, extrapulmonary manifestations of sarcoidosis, the results of pre-test spirometry, ECG, echocardiography and CPT were evaluated.
Results. A decrease of peak oxygen consumption (VO2 peak) in mild stage (71-84 %) was found in 23, moderate one (51-70 %) in 10 examined. Patients with reduced physical activity (PA) (VO2 peak ≤84 %) did not have significant differences in terms of clinical disease course, X-ray stages, echocardiography results, but more often had respiratory disorders (6 (18.2 %) and 1 (2.1 %), p = 0.018). In 16 patients with PS, hemodynamic factors were the leading cause of the decrease in PA, 9 were diagnosed with respiratory disorders, in 7 cases there was detraining, and obesity in 1 case. Concurrent cardiovascular diseases (OR = 8.998, 95 % CI 2.06-39.34) and end-systolic volume (OR = 0.92, 95 % CI 0.86-0.99) respiratory disorders - FEV1were predictors of hemodynamic limitations.
Conclusion. Reduction of PA in patients with PS was observed in 41.3 % of cases and was caused by hemodynamic (n = 16) or respiratory disorders (n =

The aim of the research is to reveal the role of collagen gene polymorphisms (COL1A1) -1997 C> A and 1546 (6252) G> T [Sp1 S> s] in rachitis development.
Material and methods. During the study 108 full-term children from Chita city aged from 3 months to 2 years were examined, 82 of which had rachitis and 26 were healthy ones. 2 groups were distinguished: children with I health group, without any signs of rachitis and children with clinical signs of rachitis, further there were 4 groups subdivided. The study of C-terminal telopeptide of collagen type I (Beta-Cross Laps) serum level was carried out by ELISA reagents CEA892Hu 96 (USA). DNA samples isolated from peripheral venous blood were the material for gene mutations study. Mutation points of collagen gene (COL1A1) -1997 C> A and 1546 (6252) G> T [Sp1 S> s] were selected by real-time PCR. Statistical data processing was carried out using software package Microsoft Excel 2010, Statistica 8.0 (StatSoft).
Results. The level of Beta-Cross Laps is increased in all subgroups, with the exception of patients with 1-st stage of acute rachitis. The highest level of Beta-Cross Laps was determined in children with moderate rachitis (1.12 [0.56; 1.60] pg / ml), which is 1.5 times more than in healthy ones. CC and CA genotypes and C allele of COL1A1 gene: -1997 C> A were more often recorded in patients. Genotype AA in acute course was determined in 10.5 % of cases, in subacute course – in 9.1 % of patients. A deviation from Hardy – Weinberg equilibrium was found for COL1A1 polymorphism: -1997 C> A in groups of children with acute course and with 1-st severity stage. Heterozygous mutant allele (GT) and homozygous mutant allele (TT) were found in 30.7 % and 2.6 % of acute cases of the disease.
Conclusion. Collagen gene polymorphisms have different values in rachitis development. Homozygous mutant allele of COL1A1 gene: -1997 C> A was
determined in all types of rachitis course and is absent in healthy children. Carriage of minor allele A of COL1A1 gene: -1997 C> A increases the risk of acute rachitis by 5 times; in this group of patients, the level of C-terminal telopeptide is 2 times higher than in healthy patients.

The aim of the research is evaluation of cardiac and renal dysfunction in patients with type 2 diabetes mellitus, hypertension and in case two nosologies are combined, clinical and functional features of patients with cardiorenal syndrome.
Material and methods. 231 people were examined. All the studied were divided into 7 groups: 1 group — patients with type 2 diabetes without hypertension, n = 18; 2 group – patients with diabetes and stage 1 hypertension, n = 19; 3 group – patients with diabetes and stage 2 hypertension, n = 52; 4 group – patients with diabetes and stage 3 hypertension, n = 29; 5 group – patients with stage 1 hypertension, n = 21; 6 group – patients with stage 2 hypertension, n = 46; 7 group – patients with stage 3 hypertension, n = 18. The control group included people without type 2 diabetes and hypertension and amounted 28 people. Glomerular filtration rate (GFR) was calculated by means of CKD-EPI formula. Urinary albumin / creatinine ratio, cystatin C, kidney damage molecule 1 (KIM-1) were used as markers of renal damage. All patients underwent ultrasound abdominal cavity and kidneys examination and echocardiography.
Results. Hypertension has the greatest impact on the progression of CKD when combined with diabetes. GFR positively correlates with the indicator of heart diastolic dysfunction – E / A peak and negatively with the body mass index and the size of the left atrium according to echocardiography. Marker of tubules KIM-1 lesion in all groups is within normal limits. In all groups, diastolic dysfunction of the left ventricle and hypertrophy of the walls of the left ventricle is expressed, with the ejection fraction preserved.
Conclusion. Chronic heart failure is present in 71 % of patients and in 27 % of patients it is combined with chronic kidney disease. In patients with
cardiorenal syndrome, filtration function of kidneys is significantly lower, estimated both by concentration of serum creatinine and cystatin C, the percentage of cardiovascular complications is higher, signs of left ventricular hypertrophy and diastolic heart dysfunction are more pronounced.

The aim of the research. In 2018, at Professor V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University of Ministry of Healthcare of Russia (hereinafter - KrasSMU), practical exam on Propaedeutics of Internal Diseases was held in two stages for the first time for third-year students of therapeutic faculty. The purpose of this study was to grade the level of practical skills of third-year students at therapeutic faculty of KrasSMU on Propaedeutics of Internal Diseases, as well as to cover the possibility to increase the objectivity while grading.
Material and methods. 402 students were graded at the first examination stage demonstrating practical skills, 411 people - at the second stage. Statistical analysis of the data was performed using application software package Statistica 7.0 (StatSoft Inc., 2004).
Results. The first stage of practical exam was held at the Department of Propaedeutics of Internal Diseases and Therapy. The second stage was carried out for the first time at the department - center of simulation technologies of KrasSMU. Examination practical skills included obligatory blocks: examination of respiratory system, examination of cardiovascular system, examination of digestive system. It was proposed to demonstrate practical skills in endocrine, urinary and other systems. At the second stage of practical exam, three additional practical skills could be offered for demonstration. The average score received by students at the first stage of practical exam was 4.0 (3.6 - 4.7), at the second stage, the average score was significantly higher and amounted up to 4.7 (4.3 - 5.0). During the second stage of practical exam, the majority of students received “good” and “excellent” grades for demonstration of three required
practical skills.
Conclusion. At the second stage of practical exam, in order to increase the objectivity of grading the level of students’ training, it was suggested be involve independent teachers, to use simulation technologies and expert assessment lists.

The aim of the research is evaluating the result of surgical treatment of new-borns diagnosed with aortic coarctation comparing surgical techniques.
Material and methods. All patients were divided into three research groups in accordance with the chosen tactics of surgical intervention: 1) reconstruction
of an arc with plastic patch according to Norwood procedure; 2) resection of the narrowed section of the aorta and plastic patch; 3) resection of the narrowed section of the aorta and application of an end-to-end anastomosis. Patients are grouped randomly. Intraoperative quality control of the operation was performed by means of TEechoCG, direct tensiometry; transthoracic echocardiography was used as examination at the discharge and in long term. A comparative assessment of the results was carried out by determining statistically significant differences in gradient on the isthmus at the discharge from the hospital and the increase of the gradient on the isthmus during the year; survival analysis was carried out according to Kaplan-Meyer, fatal outcome and the need for re-intervention for aortic recoarctation were the end-point.
Results. There were no statistically significant differences in the value of the gradient on the aortic isthmus during the discharge and statistically significant
more rapid increase in the gradient in the first research group. Significant differences in patients of this group were identified in terms of aortic recoarctation and death.
Conclusion. Complete resection of ductal tissue leads to significant decrease in frequency of aortic recoarctation in dynamics. An end-to-end anastomosis
is preferable in treatment of aortic coarctation in new-borns. If it is impossible to perform direct anastomosis, it might be supplemented with a patch giving
good long-term results.

The aim of the research is evaluating the effectiveness of applying differentiated approach to the choice of surgical access for calculous cholecystitis and determining additional criteria that could complement the existing algorithm.
Material and methods. The study consisted of 3 stages. At the first stage, based on retrospective analysis of case histories of patients with calculous cholecystitis, a differentiated approach to the choice of surgical access was developed and put into practice in our clinic. At the second stage, we evaluated the application of this algorithm. At the third stage, on the basis of prospective analysis, the possibility of using alkaline phosphatase and gamma-glutamyltransferase activity in the blood of patients with calculous cholecystitis at preoperative stage was assessed as an additional criterion in comprehensive assessment of the severity of inflammatory process in the gallbladder wall and perivesical space.
Results. The criteria chosen by us for the algorithm of differentiated approach to the choice of operative access for calculous cholecystitis made it possible
to expand the indications for laparoscopic access when laparotomy was previously performed. But despite this, conversion is to be performed in technically difficult cases. The study has proved that activity of alkaline phosphatase and gamma-glutamyl transferase in blood mainly increases in acute cholecystitis.
Conclusion Thus, the differentiated approach developed and used in our clinic has allowed to increase the number of laparoscopic cholecystectomies in
acute calculous cholecystitis. At the same time, the number of conversions of laparoscopic access to laparotomy has almost doubled. According to the results obtained, determination of alkaline phosphatase and gamma-glutamyltransferase can be used as such criteria, but only in comprehensive diagnosis along with other indicators

The aim of the research. Assessment of conserving viability of mycobacteria in lung fragments preserved in a 10% aqueous solution of formaldehyde.
Material and methods. Lungs fragments of the dead people with tuberculosis foci were recorded in 10% formalin, followed by bacteriological studies.
Results. Mycobacterium growth was detected in two from 218 lung fragments. One lung fragment was 1.0x1.0x1.0 cm in size, while the other was 2.0x2.0x2.0 cm. In the remaining 216 fragments mycobacteria growth was not detected. On this basis, it was concluded that there is a low risk for pathologists and laboratory workers to be infected when working with material taken from tuberculosis patients and preserved in formalin.
Conclusion. The given recommendations do not exclude the use of personal protective equipment while working with material collected from those infected with tuberculosis. The survival of mycobacteria in the material preserved in formalin is possible only in single cases

There are results of examination and surgical treatment of 92 patients with endometrial polyps: 35 women are of reproductive age and 57 women
are in pre- and post-menopause. All patients underwent hysteroscopy to assess the location, quantity, size and nature of polyp base; according to the obtained data various techniques were used to remove them.
When conducting hysteroscopy in patients of fertile age, in the vast majority of cases, single polyps, polyps of small size and often ones with narrow base were found. In pre- and post-menopausal patients, multiple polyps, polyps with wide base and of large sizes were significantly more likely to occur.
The only effective method for surgical treatment of endometrial polyps in patients of all age groups is hysteroscopic polypectomy. In patients of childbearing age interested in realization of reproductive function, the use of mechanical micro-tools is preferable. Patients in pre- and post-menopause are more likely to have multiple polyps, large polyps with wide base, and therefore the use of electro-resection is preferable. In addition to polypectomy, the surrounding endometrium, the state of which determines further management tactics, should be examined in patients of all age groups.

Morozov AM, Mokhov EM, Kadykov VA, Olshevskaya AS, Dukhanina MV, Pakhomov MA. Tracheoesophageal fistula as an iatrogenic complication
of polytrauma, manifestations, diagnosis, treatment. Siberian Medical Review.2020;(1):84-88

There is clinical observation demonstrating interdisciplinary approach in treating a patient with a tumour of large duodenal papilla complicated by mechanical jaundice.

Myocardial infarction remains one of the leading causes of high cardiovascular mortality in Russia and in the world. Formation of aneurysm of the left ventricle (LV) and parietal thrombus is a common complication of this incident. Thrombus in the LV cavity is a threat for the development of
thromboembolic syndrome that requires appointment of long-term therapy with indirect anticoagulants, which on the other hand are dangerous for the
development of severe haemorrhagic complications. The risk of bleeding in such cases may increase simultaneously with the decrease ischemic stroke
risk. The appointment and cancellation of indirect anticoagulants should, therefore, be done according to strict indications, however, traditional sero-scale echocardiography does not always make it possible to confirm or refute the diagnosis of thrombosis confidently. The “golden standard” for diagnosing LV thrombosis is magnetic resonance imaging (MRI). However, this technique is of high cost and is available only in highly specialized institutions, therefore, its implementation remains impossible in all situations difficult from the point of view of diagnosis. In doubtful cases, the use of ultra-sound technique “speckle tracking imaging” can help to avoid MRI appointment, showing the presence or absence of myocardial contractile tissue

The aim of the research is the study of socio-economic losses due to mortality from alcohol-related reasons in the Republic of Buryatia.
Material and methods. The data of Territorial Authority of Federal State Statistics Service for the Republic of Buryatia, SBHCI “Republic Bureau of Forensic Medical Examination” and SBHCI “Republic Pathologicoanatomic Bureau” of the Ministry of Healthcare of the Republic of Buryatia were used. Calculation of demographic loss of labour potential was made in accordance with the guidelines for the use of “Lost years of potential life” indicator.
Results. It was found that in the Republic of Buryatia for the period 1993-2017, mortality specific weight from alcohol-related reasons was 3.52 ± 0.05 % from the total mortality rate. This indicator is significantly higher among people who died being of working age, reaching the value of 6.98 ± 0.11 % in this cohort. Based on the principle of potential demography, the authors calculated social and economic damage caused by premature mortality of population of the Republic of Buryatia due to the reasons directly related to alcohol.
Conclusion. Annually social losses average 80,248.37 person-years not reaching the end of working age; for the indicated period associated economic losses in the aggregate amounted 4.1 billion rubbles